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Management of GI and Endocrine Conditions > Lecture 12 - Medicines Care Review > Flashcards

Lecture 12 - Medicines Care Review Flashcards

1
Q

Why was medicines care review introduced?

A

to make better use of pharmacists’ skills to improve patient care

combined serial dispensing and pharmaceutical care model schemes

joint working between GPs and community pharmacists

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2
Q

How is there joint work between GPs and community pharmacists?

A

identifying and prioritising risk from medicines

minimising ADRs

address existing and prevent potential problems with medicines

provide structured follow up and interventions where necessary

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3
Q

Why do we need to manage the workload?

A

More Rxs dispensed year on year

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4
Q

What is MCR?

A

Pharmaceutical care planning in the community pharmacy setting

a system of formalising the contribution to care that pharmacists deliver

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5
Q

What does MCR add to?

A

the value of our contribution and documents what we have been doing for years

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6
Q

Drivers for MCR?

A

prescribing

dispensing

compliance/concordance

workload

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7
Q

Prescribing error rate?

A

7.5%

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8
Q

Dispensing error rate?

A

3.3% of all items

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9
Q

Non adherence rate?

A

30-50%

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10
Q

Hospital admissions due to ADR?

A

2.7-6.5%

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11
Q

CMS - why do we do it?

A

improve clinical outcomes (actual and potential drug related outcomes)

improve concordance

reduce ADRs

promote self care

reduce rates of readmission to hospital

reduce wastage

patient safety

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12
Q

Why the pharmacist?

A

Ideally placed to have regular contact with the patient

  • patients like time with the pharmacist
  • ease of access due to longer opening hours and locations

highly skilled in use of medication

good communication skills

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13
Q

How much income does CMS generate?

A

19% of income, 38% from dispensing

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14
Q

How do pharmacies get money from CMS?

A

each pharmacy has a target number of patients to look after based on the number of patients they service - meet or go above target to make money

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15
Q

Which patients?

A

targeted to patients that need it (quality not quantity)

have one or more LTC that requires medication e.g. asthma, CHS, diabetes

new medications

high risk meds (warfarin, methotrexate, lithium)

smoking cessation

gluten free foods annual health check

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16
Q

Patient Eligibility for CMS?

A

all patients with a long term condition are eligible

all registered patients are eligible to receive pharmaceutical care package from pharmacist

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17
Q

What patients are NOT suitable for a serial script?

A

drugs subject to dose titrations

patients subject to frequent medication changes/hospital admissions

controlled drugs (2-4) and cytotoxics (methotrexate_

drugs needing close monitoring may/may not be suitable

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18
Q

What is stage 1?

A

registering the patient

19
Q

What does registration include?

A

patient registers with pharmacy of their choice (one pharmacy)

underpinned by explicit patient consent - must be explained to the patient at the time of registration

selection must be done either directly or under the supervision of a pharmacist

20
Q

What is registration done via?

A

the patient registration system (PRS) hosted at the national services scotland (NSS)

21
Q

Eligibility for registration?

A

patient must be registered with a scottish GP practice

patient must have long term conditions

not a resident in a care home (nursing or residential)

22
Q

Data required to register a patient?

A

name, gender, address including postcode, date of birth, exemption status, community healthy index (CHI) number

23
Q

What is generated during registration?

A

paper registration form which is signed by both patient and pharmacist

24
Q

What does the GP receive?

A

an electronic registration notification message ONLY if patient is exempt from prescription charges on age or medical grounds

25
Q

Withdrawal from CMS?

A

can be done under patients choice, if they are not eligible anymore and if they register at a new pharmacy

26
Q

What is stage 2?

A

Pharmaceutical care planning

27
Q

When must stage 2 be undertaken by?

A

within 12 weeks of registration

28
Q

Who needs to do the pharmaceutical care planning?

A

the pharmacist

priorities assigned to help pharmacist target patients in most need of support

patients and pharmacist discussion to agree outcomes

29
Q

What happens during pharmaceutical care planning?

A

identify actual and potential problems

document issue/action/outcome

monitor, review and update the care plan

may involve other healthcare professionals (BP check or biochemical test)

link to patients PMR (must be documented)

30
Q

what must be completed to receive payment?

A

stage 1 and stage 2

31
Q

What does the patient profile include?

A

general health, medical conditions, allergies and sensitivities, patient factors, care plan priority

32
Q

What is the medication profile?

A

questionnaire on the patients medicines based on yes or no questions

33
Q

What is the pharmaceutical care plan?

A

documents the care issues, desired outcomes and the actions

helps to monitor, review and update progress against the agreed actions

34
Q

What is stage 3?

A

serial dispensing

35
Q

Who is the decision for serial dispensing made by?

A

GP or the pharmacy

depends on the healthy board

36
Q

How many weeks at a time can be prescribed?

A

24, 48 or 56 weeks, dispensed at time intervals determined by the GP

37
Q

What happens if someone required medication early (e.g. for a holiday)?

A

can be dispensed at pharmacists discretion

38
Q

What does disease specific control determine?

A

referral criteria and reporting requirements as well as specific pharmacy care issues for that condition

39
Q

What happens during serial dispensing?

A

pharmacist downloads electronic version of the serial prescription prior to dispensing to ensure working on most recent e version

e claim send and e message to GP

should be convenient to GP but underestimates how erratic patients are

40
Q

What works well for serial prescribing?

A

choosing the correct patients - patient education is key!

41
Q

What medication needs to be added to a serial prescription?

A

ALL or nothing to start, can progress to prn

42
Q

What is important for serial prescribing?

A

all prescribers known how to make changes to the script and communicate this change

knowing when patient is no longer suitable

communication between practice and community pharmacy

43
Q

Benefits to practice of SRx?

A

manages increasing workload

SRx already in some area

reduces repeat prescribing in GP practice

supports patients

increased direct contact with patients with trained HC professional

pharmaceutical care delivery

> 100 SRx in CP will ensure it becomes normal pratice

8-10% of practice list size then begin to see impact on workload

Management of GI and Endocrine Conditions (24 decks)

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